ANÁLISE DE INDICADORES DE SAÚDE NO BRASIL

  The analysis of health indicators plays a fundamental role in evaluating and monitoring a country's health system. In Brazil, this practice is essential for understanding the population's health situation and guiding effective public policies. In this study, we performed an integrative literature review to examine the approach, objectives and results of the analysis of health indicators in the Brazilian context. The objective of this study is to analyze the approach, objectives and main results of the analysis of health indicators in Brazil, through an integrative literature review. We conducted an integrative literature review, conducting searches in electronic databases such as PubMed, Scopus and the Virtual Health Library (VHL), using the following descriptors in Portuguese: health indicators, health analysis, Brazil. Studies published between 2010 and 2022 that addressed the analysis of health indicators in the Brazilian context were included. Studies that were not related to the topic, repeated studies and works in a foreign language were excluded. The analysis of health indicators in Brazil is an essential practice for evaluating and directing effective health policies. Through this integrative review, we observed that this approach is widely used to monitor specific diseases, assess the quality of health services and identify regional inequalities. The results of this analysis contribute to informed decision-making and the continuous improvement of the Brazilian healthcare system. However, it is important to emphasize the need to constantly update the indicators and the methodology used, in order to guarantee the accuracy and relevance of the analyses.A análise de indicadores de saúde desempenha um papel fundamental na avaliação e no monitoramento do sistema de saúde de um país. No Brasil, essa prática é essencial para compreender a situação da saúde da população e orientar políticas públicas eficazes. Neste estudo, realizamos uma revisão integrativa da literatura para examinar a abordagem, os objetivos e os resultados da análise de indicadores de saúde no contexto brasileiro. O objetivo deste estudo é analisar a abordagem, os objetivos e os principais resultados da análise de indicadores de saúde no Brasil, por meio de uma revisão integrativa da literatura. Realizamos uma revisão integrativa da literatura, conduzindo buscas em bases de dados eletrônicas, como PubMed, Scopus e Biblioteca Virtual em Saúde (BVS), utilizando os seguintes descritores em português: indicadores de saúde, análise de saúde, Brasil. Foram incluídos estudos publicados no período de 2010 a 2022 que abordassem a análise de indicadores de saúde no contexto brasileiro. Foram excluídos estudos que não estivessem relacionados ao tema, estudos repetidos e trabalhos em língua estrangeira. A análise de indicadores de saúde no Brasil é uma prática essencial para avaliar e direcionar políticas de saúde eficazes. Através desta revisão integrativa, observamos que essa abordagem é amplamente utilizada para monitorar doenças específicas, avaliar a qualidade dos serviços de saúde e identificar desigualdades regionais. Os resultados dessa análise contribuem para a tomada de decisões informadas e o aprimoramento contínuo do sistema de saúde brasileiro. No entanto, é importante ressaltar a necessidade de atualização constante dos indicadores e da metodologia utilizada, a fim de garantir a precisão e a relevância das análises

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)